FOCUSonDIAGNOSIS
Patient Selection: Understanding Overlooked Sleep Disordered Breathing Symptoms by Mayoor Patel, DDS, MS, RPSGT
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here are many signs and symptoms to look for in our patients that are indicative of Sleep Disordered Breathing (SDB), but what signs and symptoms could we be missing? We can simply ask our patients how well they’re sleeping, but when answering that question; many patients won’t consider that they may be suffering from the most common form of SDB, Obstructive Sleep Apnea (OSA). The typical patient does not fully understand the consequences of untreated OSA, so in this article, I will discuss the visual indicators of OSA to look out for that could potentially save your patients’ lives, and reiterate that dentists are at the forefront for identifying and treating OSA with oral appliance therapy. I have included findings from an internal analysis I conducted in my practice that supports these visual indicators as indicative of OSA.
SDB Symptoms Overlooked
Table 1 Lateral tongue scalloping Mallampati classification of grade 3 or 4 Cervical abfractions Tooth wear (occlusal) Vaulted palate / unilateral crossbite Retrognathic mandible / Class II molar relationship Bicuspid extracted orthodontic cases
54 DSP | Spring 2017
As dentists, we see our patients more regularly, and for longer periods of time than most other healthcare professionals. During your patients’ routine dental visits, it is important that not only we as dentists but our team members be on the lookout for both the obvious and not-so-obvious signs and symptoms. The obvious include reported snoring and choking/gasping during sleep, daytime fatigue, large neck circumference, and retrognathia. So what are some of the not-so-obvious signs and symptoms that we may be overlooking? Some predictions of OSA probability include bruxism, abfractions, enlarged tongue size or a vaulted palate. The first example, bruxism, may be a way for the brain to attempt to reopen the airway in an unconscious state. Frequently, a patient who grinds their teeth at night has sore or clicking jaw joints, or flat, worn-down teeth. On the other hand, symptoms of bruxism might even be far less obvious, including earaches or sensitive teeth. Dentists need to be on the lookout for all symptoms and conditions beyond abfractions that might signal grinding and an even deeper problem. Evaluating tongue and palate size, uvula (elongated/ battered) and airway space takes only min-
utes and can easily become standard in a routine dental exam.
Positive Intraoral Findings
As seen in the Summer 2016 issue of Dental Sleep Practice, there are many intraoral findings that strongly suggest a patient at high risk for some form of SDB. The question is: what do we do with these findings? After dental school, we are immersed in the mindset of prevention, biannual dental hygiene appointments to prevent periodontal disease, placement of dental sealants to prevent caries, interceptive orthodontics and the list goes on. So why not prevent or reduce the risk of hypertension, cardiovascular disease, diabetes, stroke, and other conditions that are linked to OSA? In my opinion, as well as others’ opinions, we need to take a strong stand and become more active in assisting our medical colleagues in identifying potential patients at risk. Remember, early treatment is key to preventing the development of worsening symptoms and dangerous conditions. To illustrate the power of your clinical judgment, I engaged in an internal analysis of patients that I identified with any of the indicators listed in Table 1. In 2010, I screened my patients for the visual indicators listed in
